Germ Cell Tumours Flashcards
dont do this deck Are germ cell tumours common?
No, they are rare
What % of testicular tumours are germ cell tumours?
95%
What % of ovarian malignancies are germ cell tumours?
3-5%
When are germ cell tumours the most common cancer?
In men aged 20-40
When is the peak incidence of ovarian GCT?
Young women and adolescent girls
What % of GCT do extra-gonadal tumours account for?
Less than 10%
Where do extra-gonadal GCT occur?
In midline structures, most commonly in mediastinum and retroperitoneum, and rarely the brain, head, and neck
When is the peak incidence of GCT in the mediastinum?
3rd decade of life
What is the strongest risk factor for testicular GCTs?
Family history of testicular cancer
What are the other risk factors for testicular GCT?
- History of maldescent
- History of torsion
- Kleinfelter’s syndrome
- Atrophic testis
- Previous testicular cancer
- Infertility
- In utero exposure to oestrogens
What genetic abnormality is found in more than 80% of testicular cancers?
12p gain, often as an isochromosome of 12p, where one arm of the chromosome is lost and replaced with an exact replica of the other arm
What is the precursor to testicular GCT?
Carcinoma in situ
What % of malignant GCT in men are seminomas?
50%
When is the peak incidence of seminomas?
30-40
When is spermatic seminoma more common?
Older men (60-70)
What female cancer is directly comparable with testicular seminomas?
Ovarian dysgerminoma
What accounts for the majority of cases of ovarian GCTs?
Ovarian dysgerminoma
What % of patients present with seminoma/dysgerminoma confined to the testis/ovary?
75%
Describe the spread of seminoma/dysgerminoma?
It is usually predictable, from the para-aortic to supra-diaphragmatic nodes, and then to extranodal sites
What is the result of the growth of seminoma/dysgerminoma being slow?
It may take up to 10 years to present clinically
Do seminomas/dysgerminomas produce tumour markers?
They do not produce a reliable tumour marker, but hCG can be elevated in 10-25% of cases
How do non-seminoma GCT compare to seminomas, in terms of spread?
Disease spread occurs earlier
What is the result of disease spread occuring earlier in non-seminoma GCTs?
Only 50% of patients present with localised disease
What tumour markers are associated with non-seminoma GCTs?
AFP and hCG
What % of cases of non-seminoma GCTs have elevated AFP and hCP?
75%
How do testicular GCTs present?
- Painless solid mass in scrotum
- Enlargement of testicle
- Scrotal pain (i guess the actual lump doesnt hurt, but the scrotum does?)
- Back pain
- Dragging sensation in scrotum
- Gynaecomastia
What causes gynaecomastia in testicular GCTs?
High circulating hCG levels
What might the presenting features of testicular GCTs be similar to?
Epididymo-orchitis
When should epididymo-orchitis raise suspicion of testicular GCT?
If it does not respond to antibiotics
